Optum sponsored an executive roundtable at the Becker's 2024 Annual Meeting, facilitated by
- Ken Leonczyk, Jr., senior vice president, provider partnership strategy, Optum
- Edward Yoon, MD, national medical director and chief medical officer, market performance partnerships, Optum
“The U.S. healthcare system is in the midst of a generational shift. Patients are looking for whole-person care delivered when they want it, where they want it”, Mr. Leonczyk said However, for providers, it is becoming increasingly difficult to deliver this care in an affordable way. Many knowledgeable healthcare experts believe that value-based care is the best path forward.
Four key takeaways from the roundtable:
- No single definition exists for value-based care. Every market is unique. "When I held a chief strategy officer role, we worked with actuaries and found that each market is a little different," one participant said. "For example, Texas and Tennessee are all fee-for-service, while Michigan and Indiana are value-based. It depends on the organization's circumstances, geography and local dynamics."
- Many hospitals and health systems struggle to get compensated for new approaches to care. A participant from a payer that owns hospital systems described a model that focuses on the relationship between physicians and patients. The goal is to use the physician-patient relationship to build out value-based care and keep people out of the hospital.
"That's a great example of value-based care at its best," Mr. Leonczyk said. "If you're not a payer that owns a health system, however, it's a great way for a healthcare organization to go out of business. If you're doing an enormous amount of work to keep people out of the system and you're in no way benefiting from that, how do you continue to provide care? - Involvement in upside and downside risk agreements can be very complicated. An urban hospital on the West Coast takes managed Medicaid risk with its federally qualified health centers. The hospital is in about six independent physician association networks and it also works with two to three health plans.
"It's a complicated and convoluted system to get some percentage of the capitation that allows us to offer the whole-person care we want to provide to patients," the participant said. "We know it's the right thing to do and it ultimately reduces the total cost of care, but it's very complicated." - Partnerships can help health systems deliver the care that patients want and deserve. Optum's goal is to ensure that health systems anchored by acute care facilities can provide the highest-quality, lowest-cost care to patients. A good example is a health system partner that is at the top level of quality and appropriate utilization. This organization recently tried to renegotiate with payers to increase its rates and the payers said no.
"We are now bringing in a team to get this organization closer to the premium dollar," Dr. Yoon said. "We all want to do the right thing, but sometimes it's hard. That's where partnerships come in."
In today's world, there's a power and financing differential between payers, providers, and patients. Health systems need to find a way to renegotiate and get appropriately reimbursed for providing the kind of care that will naturally result in more appropriate utilization. "Optum is enabling health systems to re-think their care delivery and reimbursement models to ensure that systems can continue to support their acute care facilities and provide excellent care in the community," Mr. Leonczyk said. "If we could help you get appropriately reimbursed for truly providing whole-person care, it would change the entire landscape."